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中华航空航天医学杂志
中华航空航天医学杂志

卢志平

季刊

1007-6239

hkbjb@sina.com

010-66927182

100142

北京市阜成路28号

中华航空航天医学杂志/Journal Chinese Journal of Aerospace MedicineCSCDCSTPCD
查看更多>>1990年创刊，中华医学会主办。本刊以中文发表论文，国内外公开发行。主要读者对象为从事航空航天医学专业的高、中级专业人员和航空航天人机工程人员。栏目设置有论著、临床论著、综述、航医实践、病例报告、述评、专题论述、国际学术交流、人物述林、学术讲座、读者来信和消息报道等。刊文内容涉: 航空医学、航天医学、航空航天生理学、航空航天神经生理学和(或)视觉科学、各种加速度影响及其防护、航空航天人机工程、航空航天操纵技能与心理生理学、航空医疗运输等。
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    2012—2021年暂时飞行不合格军事飞行人员疾病谱分析

    陆勤燕倪春慧徐建华陈悦...
    65-70页
    查看更多>>摘要：目的 总结年度体检结论“暂时飞行不合格”军事飞行人员疾病特点，分析疾病谱变化规律，为航空卫生保障工作的持续改进提供数据支撑。 方法 回顾性分析2012—2021年于空军杭州特勤疗养中心行年度体检，且航空医学鉴定结论为暂时飞行不合格的军事飞行人员的临床资料，以5年为限，分为2012—2016年组、2017—2021年两组，统计比较两组暂时飞行不合格军事飞行人员疾病、年龄、飞行机种分布情况。 结果 共纳入飞行人员522例，年龄23~55岁，飞行时间100~20 000 h。2012—2016年组242例，2017—2021年组280例。与2012—2016年组相比，2017—2021年组新增疾病9种，排名前10位疾病中肺结节、高血压、糖尿病、肿瘤指标异常、大便隐血阳性的占比升高，甲状腺结节、肝功能异常、心律失常占比下降。两组暂时飞行不合格人员年龄分布差异有统计学意义（χ2=20.97，P<0.001），2017—2021年组中≥40岁人数所占比例增加。2017—2021年组中歼教机飞行员、轰运机飞行人员比例增加，差异有统计学意义（χ2=14.66，P=0.001）。 结论 近年来暂时飞行不合格军事飞行人员疾病谱疾病种类增多，且以隐匿性疾病为主。由于目前特勤疗养机构普遍仅在出院2个月内进行电话回访，而对于某些隐匿性疾病需长期观察才能确定对飞行的影响，因此应建立长期有效的回访制度。 Objective To provide data support for the improvement of aeromedical support by summarizing the disease characteristics and analyzing the change pattern of disease spectrum for the temporarily grounded military flying personnel assessed in the annual physical examination. Methods The clinical data of military flying personnel who were assessed as temporary grounding in the annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from 2012 to 2021 were retrospectively analyzed. They were divided into 2012—2016 group and 2017—2021 group with a 5-year span. The distributions of disease, age and aircraft type were statistically compared between 2 groups of temporarily grounded military flying personnel. Results A total of 522 flying personnel, aged from 23-55 years and flew 100-20 000 h, were enrolled. There were 242 cases in 2012—2016 group and 280 cases in 2017—2021 group. Compared with 2012—2016 group, 2017—2021 group was found 9 new diseases. Among the top 10 diseases in 2017—2021 group, the proportion of pulmonary nodules, hypertension, diabetes, abnormal tumor indicators, positive fecal occult blood was increased, and the proportion of thyroid nodules, abnormal liver function, arrhythmia was decreased. There was a significant difference in the age distribution between 2 groups of temporarily grounded military flying personnel (χ2=20.97, P<0.001). The proportion of flying personnel aged ≥40 years old was increased in 2017—2021 group. The proportion of fighter-trainer pilots and bomb-transporter flying personnel increased in 2017—2021 group, and the difference was significant (χ2=14.66, P=0.001). Conclusions In recent years, more diseases, mostly occult diseases, are found in the disease spectrum of the temporarily grounded military flying personnel. Since some insidious diseases require more time to observe their convalescent effect and the influence to flight but the routine phone follow-up is called within 2 months of discharge, so a long-term and effective follow-up mechanism is suggested.

    疾病谱体格检查合格鉴定飞行人员

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    军事飞行人员颅脑MRI筛查结果分析及航空医学鉴定

    梁明龙朱金旺王雷徐建华...
    71-77页
    查看更多>>摘要：目的 分析军事飞行人员颅脑MRI筛查结果，从影像学角度提升对军事飞行人员颅脑疾病和航空医学鉴定的认识。 方法 回顾性分析2020年9月至2021年12月于空军杭州特勤疗养中心行年度体检的军事飞行人员颅脑MRI筛查结果。按年龄分为20~29、30~39、40~49和50~59岁4个组；按照飞行机种及职别，分为歼击机飞行员、轰运机飞行员、直升机飞行员和空中战技勤人员4个组。比较不同年龄、飞行机种及职别组飞行人员颅脑MRI筛查结果检出情况，分析检出异常结果对航空医学鉴定结论的影响。统计分析α水平设为0.05，组间两两比较以P<α/统计次数为差异有统计学意义。 结果 975名军事飞行人员颅脑MRI筛查中未见明显异常473例，Willis环变异194例，脑先天畸形27例，脑血管疾病54例，脑白质高信号（white matter hyperintensities，WMHs）279例，肿瘤及肿瘤样病变22例，蛛网膜囊肿26例，空泡蝶鞍29例，颅内钙化7例，颅脑外伤2例。20~29岁及30~39岁组未见明显异常比例高于其他年龄组；40~49、50~59岁组WMHs检出率高于其他年龄组；50~59岁脑血管疾病及空泡蝶鞍检出率均高于其他年龄组，差异均有统计学意义（P均<α/6=0.008）。歼击机飞行员与直升机飞行员未见明显异常比例高于其他飞行人员；空中战技勤人员WMHs检出率高于其他飞行人员；轰运机飞行员蛛网膜囊肿检出率高于歼击机飞行员，差异均有统计学意义（P均<α/6=0.008）。颅脑MRI筛查检出的异常结果多数对航空医学鉴定结论无明显影响；影响较大的为脑血管疾病、肿瘤及肿瘤样病变（P均<α/351<0.001）。 结论 本次筛查从影像学角度初步阐释了不同年龄、飞行机种和职别军事飞行人员颅脑疾病分布的基本特征，为动态随访和精准航空医学鉴定提供了依据。 Objective To improve the understanding of craniocerebral diseases and aeromedical assessment from the perspective of imaging by analyzing the results of craniocerebral MRI examination of military flying personnel. Methods The results of craniocerebral MRI examination were retrospectively analyzed among the military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from September of 2020 to December of 2021. They were divided into 20-29 years group, 30-39 years group, 40-49 years group, 50-59 years group according to the age, and they were divided into fighter pilots, bomb-transporter pilots, helicopter pilots, air combat/technical personnel according to the aircraft type and post. The detection of craniocerebral MRI examination results of the flying personnel in different age groups and aircraft type and post groups were compared. The influence of abnormal results on the conclusion of aeromedical assessment was analyzed. The α level of statistical analysis was set at 0.05, and the difference was statistically significant with P<α/statistical count for pairwise comparison among groups. Results Among the craniocerebral MRI examination results of 975 military flying personnel, 473 cases were with no obvious abnormality, 194 were anatomical variation of Willis circle, 27 were congenital brain malformation, 54 were cerebrovascular disease, 279 were white matter hyperintensities (WMHs), 22 were tumor and tumor-like lesions, 26 were arachnoid cyst, 29 were empty sella, 7 were intracranial calcinosis and 2 were craniocerebral trauma. The proportion of no obvious abnormality in 20-29 years group and 30-39 years group were higher than those in other age groups the detection rates of WMHs in 40-49 years group and 50-59 years group was higher than those in the other age groups the detection rates of cerebrovascular diseases and empty sella in 50-59 years group were higher than those in the other age groups, and the differences were significant (all P<α/6=0.008). The proportion of no obvious abnormality in fighter pilots and helicopter pilots were higher than those in others the detection rate of WMHs in air combat/technical personnel was higher than that in others the detection rate of arachnoid cyst in bomb-transporter pilots was higher than that in fighter pilots, and the differences were significant (all P<α/6=0.008). Most of the abnormal results detected by craniocerebral MRI examination had no significant impact on the conclusion of aeromedical assessment, and those with greater impact were cerebrovascular disease, tumor and tumor-like lesions (both P<α/351=0.001). Conclusions The MRI examination not only preliminarily explains the basic characteristics of the distribution of craniocerebral diseases among military flying personnel of different ages, aircraft types and posts from the perspective of imaging, but also provides the basis for dynamic follow-up and accurate aeromedical assessment.

    磁共振成像体格检查合格鉴定颅脑疾病军事飞行人员

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    军事飞行人员脑海绵状血管畸形10例及航空医学鉴定

    张成业张晖于东睿舒成...
    78-84页
    查看更多>>摘要：目的 探讨军事飞行人员脑海绵状血管畸形（cerebral cavernous malformations，CCM）的诊疗及航空医学鉴定。 方法 收集空军特色医学中心2015—2021年收治的诊断为CCM的飞行人员临床资料及航空医学鉴定结论，结合国内外相关鉴定案例及文献进行分析。 结果 共收集10例飞行人员病例，均为男性，年龄20~41岁，平均年龄28.3岁。其中飞行员8例，空中战技勤人员2例。飞行时间110~4 000 h，平均飞行时间1 102.0 h。病灶大小3~12 mm，其中<5 mm 2例，5~10 mm 6例，>10 mm 2例。病灶位置包括枕叶（1例）、额叶（4例）、颞叶（2例）、小脑半球（3例），均位于皮层下。10例飞行人员中，仅有1例首发症状为颅内出血（右侧小脑半球），予以手术治疗。3例飞行人员处于地面观察期，航空医学鉴定结论为暂时飞行不合格。其余7例飞行人员随访时间均超过6个月，复查MRI示病变均无改变、脑电图无异常，其中2例空中战技勤人员航空医学鉴定结论为飞行合格；1例直升机飞行员鉴定结论为飞行合格（限副驾驶），2例双座歼击机飞行员鉴定结论分别为飞行合格（限双座机）、飞行合格，2例单座歼击机飞行员鉴定结论为更改原机种后飞行合格（限轰炸机、运输机和直升机）。 结论 对于CCM军事飞行人员应根据有无症状、病变部位和大小、失能可能性评估、治疗效果、地面观察随访结果以及飞行机种和职别做出航空医学鉴定结论。 Objective To investigate the diagnosis, treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations (CCM). Methods The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad. Results A total of 10 flying personnel, all male, 20-41 years old, with an average age of 28.3 years, including 8 pilots, 2 air combat/technical personnel, with the flying hours of 110-4 000 h and the average flying hours of 1 102.0 h. The sizes of lesions were 3-12 mm, including 2 cases were smaller than 5 mm, 6 cases were 5-10 mm and 2 cases were bigger than 10 mm. All lesions were located under the cortex, including a case of occipital lobe, 4 cases of frontal lobe, 2 cases of temporal lobe and 3 cases of cerebellar hemisphere. Among the 10 flying personnel, only a case presented intracranial haemorrhage (right cerebellar hemisphere) as first symptom and was treated surgically. Three cases were temporarily grounded due to they were under the grounding observation. Other 7 flying personnel had been followed up for more than 6 months. Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities. Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot, and 2 dual-seat fighter pilots were qualified (limited to dual-seat fighter) and flight-qualified respectively. Two fighter pilots were qualified for lower performance aircraft (limited to bomber, transporter or helicopter). Conclusions For CCM military flying personnel, the aeromedical assessment conclusion should be made according to the symptoms, lesion location and size, inflight incapacitation possibility assessment, treatment effect, ground observation and follow-up results, as well as the aircraft type and occupation.

    血管瘤,海绵状合格鉴定航空医学飞行人员

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    57例飞行人员甲状腺癌临床特征分析

    毛志远王宇刘菊琴于海燕...
    85-89页
    查看更多>>摘要：目的 分析飞行人员甲状腺癌患者的临床特征，提高飞行人员甲状腺癌的诊治水平。 方法 回顾性分析2010年1月—2022年12月空军特色医学中心诊治的飞行人员甲状腺癌患者的临床及病理资料，分别采集年龄、飞行时间、飞行机种、确诊时的甲状腺功能等临床特征，以及肿瘤部位和大小、淋巴结转移情况、钙化及砂粒体情况、Ki-67阳性比例等病理特征，并对临床特征和病理特征进行统计分析。 结果 本组57例飞行人员甲状腺癌均以体检检出甲状腺结节为首发，发病年龄22~58岁，中位年龄37岁，飞行时间4~18 000 h，中位飞行时间2 000 h；双侧甲状腺均有检出甲状腺癌，组织学类型均为甲状腺乳头状癌，检出时甲状腺功能多数正常。甲状腺癌淋巴结转移与肿瘤大小呈低度正相关（r=0.304，P=0.021），与Ki-67阳性比例呈低度正相关（r=0.360，P=0.006）；其余临床和病理特征未见明确相关性。随着飞行时间的延长，飞行人员甲状腺癌发生淋巴结转移的概率增大，差异有统计学意义（χ2=6.32，P=0.012）；而不同年龄、飞行机种飞行人员的临床特征差异无统计学意义（P>0.05）。 结论 飞行人员甲状腺癌确诊时往往无临床症状，甲状腺功能基本正常，应加强体检中甲状腺超声的检查，对检出甲状腺结节的飞行人员应行进一步检查。 Objective To improve the diagnosis and treatment of thyroid carcinoma in flying personnel by analyzing the clinical characteristics of thyroid carcinoma. Methods The clinical and pathological data of flying personnel with thyroid carcinoma diagnosed and treated by Air Force Medical Center of PLA from January of 2010 to December of 2022 were retrospectively analyzed. Clinical characteristics such as age, flying hours, aircraft types, thyroid function at diagnosis, and pathological characteristics such as tumor site, tumor size, lymph node metastasis, calcification and sand and Ki-67 positive ratio were collected, and the clinical and pathological characteristics were statistically analyzed. Results Thyroid nodule was found as the first diagnosis of thyroid carcinoma in 57 flying personnel. The age of onset was 22-58 years old, the median age was 37 years old, the flying hours was 4-18 000 h, and the median flying hours was 2 000 h. Thyroid carcinoma was detected in both thyroid glands, and the histological type was papillary thyroid carcinoma. Thyroid function was normal in most cases when thyroid carcinoma was detected. Lymph node metastasis of thyroid carcinoma was low positively correlated with tumor size (r=0.304, P=0.021), and was low positively correlated with the positive proportion of Ki-67 (r=0.360, P=0.006). Other clinical and pathological characteristics did not show clear correlation. With the extension of flying hours, the incidence of lymph node metastasis of thyroid carcinoma increased, and the difference was statistically significant (χ2=6.32, P=0.012). There was no statistical difference among the clinical characteristics of flying personnel with different age and aircraft types (P>0.05). Conclusions The thyroid carcinoma is usually diagnosed without clinical symptoms and the thyroid function is basically normal. The thyroid ultrasound examination should be emphasized during physical examination, and further examination should be conducted for the flying personnel with thyroid nodules.

    甲状腺癌临床特征飞行人员

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    民航飞行员心肌桥对心室复极影响的调查

    杨志勤万锐雷方杨俊华...
    90-96页
    查看更多>>摘要：目的 调查民航飞行员心肌桥的检出情况及心肌桥飞行员心室复极是否存在异常，探讨心肌桥对心室复极的影响。 方法 采用回顾性研究，分析2019年≥40岁的民航飞行员次极量平板运动试验资料。排除患有影响心室复极的心血管疾病者。测定飞行员运动前静息心电图及运动结束后1 min QT间期，计算QT间期离散度（QT dispersion，QTd）。根据是否检出心肌桥分为心肌桥组和对照组，对比分析心肌桥组与对照组飞行员的平板运动试验阳性率及室性早搏发生率。对行24 h动态心电图检查者，统计分析QT/RR斜率。 结果 共有243例飞行员纳入研究，其中男性242例，女性1例。243例民航飞行员中检出心肌桥27例，主要见于左冠状动脉前降支（25/27，92.6%）；17例行24 h动态心电图检查，其中心肌桥组6例，对照组11例。心肌桥组飞行员总飞行时间多于对照组，差异有统计学意义（Z=2.29，P=0.022）；次极量平板运动试验的阳性率或可疑阳性率及室性早搏的发生率均高于对照组，差异有统计学意义（χ2=52.74、5.78，P<0.001、=0.016）；平板运动试验恢复1 min后QTd延长大于对照组，差异有统计学意义（Z=-2.20，P=0.028）；24 h室性早搏的平均发生次数、QTe/RR斜率和QTa/RR斜率高于对照组，差异均有统计学意义（t=2.37、4.26、2.51，P=0.034、<0.001、=0.024）。 结论 飞行员心肌桥可能导致心室复极时间延长，易发生室性心律失常。平时航空卫生保障工作中应重视心肌桥飞行员的体检和飞行适应性评定，尤其要加强对心室复极异常飞行员的日常健康管理，以确保飞行安全。 Objective To investigate the detection of myocardial bridge in civil aviation pilots and whether there is abnormal ventricular repolarization in the pilots with myocardial bridge, and to explore the effect of myocardial bridge on ventricular repolarization. Methods Retrospective study was used to analyze the data of submaximal treadmill exercise test in 2019 for the civil aviation pilots aged ≥40. Pilots with cardiovascular diseases affecting ventricular repolarization were excluded. The resting electrocardiogram before exercise and 1 min QT interval after exercise were measured, and the QT dispersion (QTd) was calculated. The pilots were divided into myocardial bridge group and control group according to whether myocardial bridge was detected. The positive rate of treadmill exercise test and the incidence of ventricular extrasystole were compared between the pilots in myocardial bridge group and control group. The QT/RR slope was statistically analyzed in the pilots received 24 h electrocardiogram monitoring. Results A total of 243 pilots were enrolled, including 242 males and 1 female. Among the 243 cases, 27 cases of myocardial bridge pilots were detected, and the myocardial bridge was mainly found in the anterior descending branch of left coronary artery (25/27, 92.6%). The 24 h dynamic electrocardiogram was examined in 17 cases, 6 cases were in the myocardial bridge group and 11 cases were in the control group. The total flying hours of the myocardial bridge group was longer than that of the control group (Z=2.29, P=0.022) the positive rate or suspected positive rate of submaximal treadmill exercise test and the incidence of ventricular extrasystole in the myocardial bridge group were higher than those in the control group, and the differences were significant (χ2=52.74, 5.78, P<0.001, =0.016) the 1 min QTd in the convalescent phase of the treadmill exercise test in the myocardial bridge group was longer than that in the control group, and the difference was significant (Z=-2.20, P=0.028). The average frequency of 24 h ventricular extrasystole, QTe/RR slope and QTa/RR slope in the myocardial bridge group were higher than those in the control group, and the differences were significant (t=2.37, 4.26, 2.51, P=0.034, <0.001, =0.024). Conclusions Pilots with myocardial bridge may have prolonged ventricular repolarization and are prone to ventricular arrhythmias. In order to ensure flight safety, attention should be paid to the physical examination and flight adaptability evaluation of the pilots with myocardial bridge, especially to strengthen daily health management of the pilots with ventricular repolarization abnormalities.

    室性早搏复合征冠状动脉疾病运动试验心室复极民航飞行员

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    全身抗阻力核心力量训练对飞行人员非特异性腰痛治疗效果的研究

    杨淇齐朱庆春赵艳杰黄宝珍...
    97-101页
    查看更多>>摘要：目的 探讨基于全身抗阻力锻炼（total resistance exercise，TRX）的核心力量训练对飞行人员非特异性腰痛（nonspecific low back pain，NLBP）的干预效果。 方法 选取2019年10月至2021年6月于空军杭州特勤疗养中心进行疗养的患NLBP的飞行人员为研究对象，采用简单随机抽样法分为试验组、对照组。试验组进行4周TRX核心力量训练，对照组进行4周传统核心训练。采用等速肌力测试系统对受试者的腰腹屈、伸肌群的肌力特点进行测定，并比较训练前后及两组间视觉模拟评分法（Visual Analogue Scale，VAS）评分和Oswestry功能障碍指数（Oswestry Disability Index，ODI）的差异。 结果 共纳入受试者40例，试验组和对照组各20例，均为直升机飞行人员。训练后两组受试者VAS评分均低于训练前（t=22.01、17.15，P均<0.001），且试验组VAS评分低于对照组，差异有统计学意义（t=6.55，P<0.001）。训练后两组受试者ODI评分均低于训练前（t=32.05、27.45，P均<0.001），且试验组评分低于对照组，差异有统计学意义（t=4.85，P<0.001）。训练后试验组受试者腰腹屈、伸肌群相对峰力矩均高于对照组，差异有统计学意义（t=2.65、2.41、2.04、3.31，P=0.026、0.037、0.047、0.005）。 结论 TRX核心力量训练可显著提高NLBP飞行人员腰腹屈、伸肌群的肌肉力量，可作为预防飞行人员NLBP的训练方案。 Objective To investigate the effect of core strength training based on total resistance exercise (TRX) for the flying personnel with nonspecific low back pain (NLBP). Methods Flying personnel with NLBP who recuperated in Air Force Healthcare Center for Special Services Hangzhou from October of 2019 to June of 2021 were selected. They were divided into test group and control group by simple random sampling. The test group received 4 weeks of TRX core strength training, and the control group received 4 weeks of traditional core strength training. The isokinetic muscle strength testing instrument was used to measure the muscle strength characteristics of lumbar and abdominal flexor and extensor muscle groups of the subjects. The differences in Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were compared between 2 groups before and after training. Results A total of 40 subjects were included with 20 cases in the test group and 20 cases in the control group, all of them were helicopter flying personnel. After training, the scores of VAS in both groups were lower than those before training (t=22.01, 17.15, both P<0.001), and the VAS score of the test group was lower than that of the control group, with a significant difference (t=6.55, P<0.001). After training, the ODI scores of subjects in both groups were lower than those before training (t=32.05, 27.45, both P<0.001), and the score of the test group was lower than that of the control group, with a significant difference (t=4.85, P<0.001). After training, the relative peak moment of lumbar and abdominal flexor and extensor muscle groups of the test group were higher than those of control group, and the differences were significant (t=2.65, 2.41, 2.04, 3.31, P=0.026, 0.037, 0.047, 0.005). Conclusions TRX core strength training can significantly improve the muscle strength of the lumbar and abdominal flexor and extensor muscle groups of flying personnel with NLBP, which can be used as a training program to prevent NLBP for flying personnel.

    腰痛疼痛测定飞行人员

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    个体化干预对歼击机飞行员胃食管反流发病风险的改善作用

    段长农许刚陈虹汝董燕...
    102-104页
    查看更多>>摘要：目的 分析歼击机飞行员胃食管反流的相关危险因素，探讨个体化干预对降低飞行员胃食管反流发病风险的改善作用。 方法 采取配对资料研究方法，随机整群抽取164例空军歼击机飞行员的健康风险数据，利用风险评估预测模型，分析实施个体化干预前、干预30个月后（每6个月随访1次）飞行员胃食管反流发病风险等级变化情况。 结果 飞行员发生胃食管反流症状的危险因素（高蛋白高脂肪饮食、受凉、过度疲劳、苦闷烦恼）中苦闷烦恼、受凉在干预后发生了明显改善（χ2=4.11、8.60，P=0.043、0.003）。干预后胃食管反流发病高风险的人数比干预前明显降低，差异有统计学意义（χ2=13.53，P<0.001）。随访结果显示，干预后5次随访与干预前胃食管反流发病风险分值差异有统计学意义（P=0.003），干预后第5次随访与干预前、干预后第1次随访和干预后第2次随访相比，胃食管反流发病风险分值明显下降（P<0.001、=0.040、0.010）。 结论 通过风险程度评估预测系统实施个体化干预措施，对降低歼击机飞行员胃食管反流发病风险具有积极价值。 Objective To explore the improvement effect of individualized intervention on reducing the risk of gastroesophageal reflux disease (GERD) by analyzing the related risk factors in fighter pilots. Methods The health risk data of 164 fighter pilots of the Air Force were randomly selected by the paired data study. The risk assessment and prediction model was established to analyze the changes in the risk grades of GERD among the pilots before and 30 months after individualized interventions (follow-up every 6 months). Results Among the risk factors of GERD in pilots (high-fat and high-protein diets, catching cold, excessive fatigue and annoyance), annoyance and catching cold were significantly improved after intervention (χ2=4.11, 8.60, P=0.043, 0.003). The number of participants at high risk of GERD decreased significantly, and the difference was statistically significant (χ2=13.53, P<0.001). The results of 5 follow-ups showed that there was a significant difference in the risk scores of GERD by intervention (P=0.003). At the fifth follow-up after intervention, the risk score of GERD was significantly decreased compared with that before intervention, at the first follow-up after intervention and at the second follow-up after intervention (P<0.001,=0.040, 0.010). Conclusion Individualized interventions based on the risk assessment and prediction system have positive effects on reducing the risk of GERD in fighter pilots.

    胃食管反流干预性研究危险因素飞行员

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    招飞初检学生原发性皮肤淀粉样变病1例并文献复习

    李晓龙陈雪
    105-107页
    查看更多>>摘要：目的 探讨招飞学生原发性皮肤淀粉样变病（primary cutaneous amyloidosis，PCA）的诊断、治疗及预防，提高航空医师和体检医师对皮肤病的鉴别诊断能力和航空医学鉴定水平。 方法 回顾性分析1例招飞初检学生PCA的临床诊治情况，并结合文献复习PCA的诊断和治疗。 结果 2022年1月招飞初检学生中检出1例PCA。该患者右下肢及右足背皮肤散在浅褐色斑疹，否认瘙痒等不适症状。患者曾于2007年因右下肢红褐色斑疹3年就诊，行右下肢皮损组织病理学检查，检出真皮乳头层内淀粉样蛋白沉积物，诊断为PCA。本病属于难以治愈的皮肤病，体检结论为不合格。 结论 PCA患者不适合飞行职业，招飞学生诊断为PCA者应予以招飞不合格结论。现役飞行人员明确诊断为PCA者，在治愈后或皮损面积减小、色素沉着消退、瘙痒减轻且随访期内无复发时可鉴定为合格或特许合格，航空医师应注意密切随访观察。 Objective To improve the ability of differential diagnosis of skin diseases and the level of aeromedical assessment by exploring the diagnosis, treatment and prevention of primary cutaneous amyloidosis (PCA) in flying candidate. Methods The clinical diagnosis and treatment of a case of PCA in a student recruited for the first inspection was retrospectively analyzed, and the diagnosis and treatment of PCA literature were reviewed. Results One case of PCA was detected in the students who were recruited for the initial examination in January of 2022. Physical examination revealed scattered light brown macules on the skin of the right lower extremity and dorsum of the right foot, and pruritus and other symptoms were denied. In 2007, the patient presented with a reddish-brown macule on the right lower extremity for 3 years. Histopathological examination of the right lower limb lesions revealed amyloid deposits in the dermal papillae, then the PCA was diagnosed. The disease belongs to the incurable skin disease, and the physical examination concluded as unqualified. Conclusions PCA patients are not suitable for flying occupations. The recruitment students diagnosed with PCA should be eliminated. Active flying personnel with a clear diagnosis of PCA can be identified as qualified or waivered after being cured or when the skin lesion area, pigmentation and pruritus are reduced, and no recurrence during the follow-up period. Flight surgeons should pay close attention to follow-up and observation.

    皮肤疾病体格检查人员选用招飞学生

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    民航招飞体检211例鼻窦高分辨率CT检查结果分析

    邵燕任斌周晴霖
    108-111页
    查看更多>>摘要：目的 分析民航招飞体检鼻窦高分辨率CT（high resolution computerized tomography，HRCT）检查结果，为民航招飞和航空医学鉴定工作提供依据。 方法 采用回顾性分析。选取2016年3月至2018年6月参加华东地区民航招飞耳鼻喉科体检，在民航上海医院行鼻窦HRCT检查的211例招飞学生的医学影像学资料。根据体检不合格原因分组，并比较招飞体检标准修改前后及采用不同治疗方法的慢性鼻窦炎学生体检不合格情况。 结果 211例招飞学生中合格112例（53.08%）。不合格学生所患疾病排第1位的是慢性上颌窦炎+筛窦炎，构成比为37.37%。执行新招飞标准后鼻窦HRCT检查的不合格率明显升高，差异有统计学意义（χ2=22.10，P<0.001）。37例既往有慢性鼻-鼻窦炎史的招飞学生中，保守治疗组和手术治疗组不合格人数差异无统计学意义（P>0.05）。单纯中/下鼻甲肿大组、单纯鼻道积涕组和鼻甲水肿+鼻道积涕组不合格人数比较，差异有统计学意义（χ2=10.88，P=0.004）。鼻中隔高位偏曲组不合格人数多于鼻中隔低位偏曲组，差异有统计学意义（Fisher精确检验值=0.08，P=0.040）。 结论 鼻窦HRCT检查仍是民航招飞耳鼻喉科必不可少的一种手段，在招飞体检中应正确掌握检查适应证以期提高招飞体检质量。 Objective To provide references for civil aviation recruitment and aeromedical assessment by analyzing the results of high resolution computerized tomography(HRCT) of paranasal sinuses in civil aviation pilots recruitment. Methods Retrospective analysis was used. The medical imaging data of 211 flying candidates in East China underwent HRCT examination of paranasal sinuses in the Civil Aviation Shanghai Hospital from March of 2016 to June of 2018 were selected. They were divided into groups according to the reasons of physical examination failure, and the physical examination failure status of flying candidates with chronic sinusitis who used different treatment methods before and after the revision of the medical examination standard for recruitment was compared. Results Among the 211 flying candidates, 112 (53.08%) were qualified. The first disease among unqualified flying candidates was chronic maxillary sinusitis and ethmoid sinusitis, with a composition ratio of 37.37%. After implementing the new recruitment standard, the unqualified rate of sinus HRCT examination significantly increased, with a statistically significant difference (χ2=22.10, P<0.001). Among 37 flying candidates with a history of chronic rhinitis and sinusitis, there was no significant difference in the number of unqualified between conservative treatment group and surgical treatment group (P>0.05). There were significant differences in the number of unqualified among simple middle/lower turbinate enlargement group, simple nasal discharge group and nasal edema with nasal discharge group (χ2=10.88, P=0.004). The number of unqualified in high deviation of nasal septum group was higher than that in low deviation of nasal septum group (Fisher exact value=0.08, P=0.040). Conclusions HRCT examination of paranasal sinuses is still an important method in the otorhinolaryngology department of civil aviation recruitment. Indications should be correctly grasped in order to improve the quality of physical examination in civil aviation recruitment.

    鼻窦炎体格检查合格鉴定高分辨率CT招飞学生

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    民航飞行员胆囊结石航空医学鉴定标准探讨

    武将陈雪
    112-115页
    查看更多>>摘要：胆囊结石多数无症状，部分可出现胆绞痛、腹痛、恶心或呕吐等症状，飞行因素可能会增加胆石症发病概率。我国民航重视胆囊结石的筛查和干预，预防性胆囊切除术是治疗首选。通过对比不同国家地区胆囊结石的航空医学鉴定标准，结合文献回顾，笔者认为部分无症状胆囊结石的医学失能风险在可接受的范围内，可考虑带石飞行。 The majority of gallstones was asymptomatic, and some of them had symptoms such as biliary colic, abdominal pain, nausea or vomiting. Flight factors might increase the incidence of cholelithiasis. China′s civil aviation had emphasized the screening and intervention of gallstones in civil aviation pilots, and prophylactic cholecystectomy was the first choice. By comparing the aeromedical assessment standards of gallstones and literature review, the author thinks that if the medical disability risk of some asymptomatic gallstones was within the acceptable range, the flying with stones would be considered.

    胆囊结石病预防性胆囊切除术合格鉴定民航飞行员

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